1
|
Raciti L, Raciti G, Ammendolia A, de Sire A, Onesta MP, Calabrò RS. Improving Spasticity by Using Botulin Toxin: An Overview Focusing on Combined Approaches. Brain Sci 2024; 14:631. [PMID: 39061372 PMCID: PMC11274891 DOI: 10.3390/brainsci14070631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/11/2024] [Accepted: 06/20/2024] [Indexed: 07/28/2024] Open
Abstract
Spasticity is a very common sign in the neurological field. It can be defined as "a motor disorder marked by a velocity-dependent increase in muscle tone or tonic stretch reflexes" associated with hypertonia. It leads to a high risk of limb deformities and pain that prejudices residual motor function, impairing quality of life". The treatment of spasticity depends on its severity and its location and, in general, it is based on rehabilitation, oral therapies (the gamma-aminobutyric acid b agonist baclofen) and injectable medications (i.e., botulin toxins, acting on polysynaptic reflex mechanisms). The botulin toxin type A (BoNT-A) injection has been effectively used to improve different types of spasticity. However, when BoNT-A is not sufficient, a combination of nonpharmacological approaches could be attempted. Therefore, additional intervention, such as conventional physical therapy by itself or further combined with robotic gait training, may be needed. Indeed, it has been shown that combination of BoNT-A and robotics has a positive effect on activity level and upper limb function in patients with stroke, including those in the chronic phase. The aim of this review is to evaluate the efficacy of pharmacological or nonpharmacological treatment in combination with BoNT-A injections on spasticity. The combined therapy of BoNT with conventional or adjunct activities or robot-assisted training, especially with end-effectors, is a valid tool to improve patients' performance and outcomes. The combined strategies might rise the toxin's effect, lowering its dosages of botulinum and reducing side effects and costs.
Collapse
Affiliation(s)
- Loredana Raciti
- Unità Spinale Unipolare, AO Cannizzaro, 98102 Catania, Italy; (L.R.); (M.P.O.)
| | - Gianfranco Raciti
- Department of Medical and Surgical Sciences, Magna Græcia University, 88100 Catanzaro, Italy; (G.R.); (A.A.); (A.d.S.)
| | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, Magna Græcia University, 88100 Catanzaro, Italy; (G.R.); (A.A.); (A.d.S.)
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, Magna Græcia University, 88100 Catanzaro, Italy; (G.R.); (A.A.); (A.d.S.)
| | - Maria Pia Onesta
- Unità Spinale Unipolare, AO Cannizzaro, 98102 Catania, Italy; (L.R.); (M.P.O.)
| | | |
Collapse
|
2
|
Adverse effects following botulinum toxin A injections in children with cerebral palsy. J Pediatr Orthop B 2023:01202412-990000000-00085. [PMID: 36723611 DOI: 10.1097/bpb.0000000000001055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The study aimed to analyze the adverse events associated with botulinum toxin A (BoNT-A) injections in children with cerebral palsy (CP). The literature search was completed using the Medline, PubMed, Google Scholar, Scopus, and Cochrane Library databases from the earliest date possible up to December 2021. Search terms included 'botulinum toxin', 'cerebral palsy', 'spasticity', 'adverse effects', 'side effects', 'undesirable effects', 'complications', 'lower limb', 'upper limb', and 'children' including combinations of index and free-text terms. Fifty-five studies were included in the study. Data on 6333 pediatric patients and more than 14 080 BoNT-A injections were collected. Respiratory symptoms and respiratory tract infections were the most frequently registered adverse events (AEs). Other common AEs included procedural/focal AEs, flu-like symptoms, and asthenia. Sentinel events including four cases of death were reported. AEs were more frequent and severe in high-dose patients; however, the capacity of BoNT-A to spread systemically remains unclear. Since severe adverse events are not common, further research is needed to collect more definitive clinical and homogeneous data to support the findings of the present research and clarify the safety profile of BoNT-A, especially regarding the incidence of respiratory issues and complications in GMFCS IV or V patients.
Collapse
|
3
|
Shear Wave Velocity to Evaluate the Effect of Botulinum Toxin on Post-Stroke Spasticity of the Lower Limb. Toxins (Basel) 2022; 15:toxins15010014. [PMID: 36668834 PMCID: PMC9865964 DOI: 10.3390/toxins15010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/11/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
(1) Background: The evaluation of muscles with spasticity using ultrasound elastography has attracted attention recently, and the shear wave velocity (SWV) technique can measure the mechanical properties of tissues objectively and quantitatively. The purpose of this study was to evaluate the effect of using SWV to assess the effect of Botulinum toxin type A (BoNT-A) treatment in adult patients with post-stroke lower limb spasticity. (2) Methods: We assessed the modified Ashworth Scale, the modified Tardieu Scale, and SWV at rest and after stretching before and at 1 month after BoNT-A treatment in 10 adult participants with post-stroke lower limb spasticity. (3) Results: Significant changes in SWV of the ankle joint in maximum dorsiflexion to the extent possible (SWV stretched) were observed after BoNT-A treatment. SWV stretched was positively correlated with joint range of motion. Participants whose joint range of motion did not improve (i.e., gastrocnemius medialis muscle (GCM) extension distance did not change) had significantly more reductions in SWV stretched after BoNT-A treatment. (4) Conclusions: Our results suggest that the SWV measurements may serve as a quantitative assessment to determine the effect of the BoNT-A treatment in adult stroke patients. SWV measurements to assess GCM spasticity should consider the effects of tension, material properties and activation level of muscles. The challenge is to measure SWV with matching limb positions in patients without contractures.
Collapse
|
4
|
Hara T, Niimi M, Yamada N, Shimamoto Y, Masuda G, Hara H, Abo M. Prognosis prediction of the effect of botulinum toxin therapy and intensive rehabilitation on the upper arm function in post-stroke patients using hierarchical cluster analysis. Disabil Rehabil 2022; 44:6815-6823. [PMID: 34547217 DOI: 10.1080/09638288.2021.1977394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE We analysed the effect of botulinum neurotoxin A therapy (BoNT-A) with intensive rehabilitation on the upper limb (UL) spasticity in post-stroke patients by classifying function by UL movement and examining differences in functional improvement. MATERIALS AND METHODS In this non-randomized, controlled study. The patient function was classified into groups from the score of the sub-categories of the Fugl-Meyer Assessment (FMA-UE) before treatment in the Intervention group by hierarchical cluster analysis. RESULTS A total of 139 patients in the Intervention group were classified into six groups. All groups showed a significant improvement in FMA-UE after the intervention. In the group scoring 19-31 points on the FMA-UE and with the voluntary movement of shoulder, elbow, forearm, and finger, a significant improvement was observed compared to the Control group. Further, in the group scoring 26-47 points on the FMA-UE and with the voluntary movement of shoulder, elbow, forearm, wrist, and finger, a significant improvement was observed compared to the Control group. CONCLUSIONS In this study, BoNT-A and intensive rehabilitation showed improvement in spasticity and UL function. A high therapeutic effect is expected in patients with moderate impairment levels who have voluntary movement in whole UL or in UL except for the wrist.IMPLICATIONS FOR REHABILITATIONHierarchical cluster analysis focusing on the Fugl-Meyer Assessment of the Upper Extremity sub-categories may be useful for studies aimed to improve the upper arm function.Botulinum Neurotoxin A therapy (BoNT-A) and intensive rehabilitation in post-stroke patients showed improvement in spasticity and upper arm function.The degree of the upper arm function before the intervention may affect the improvement effect of BoNT-A and intensive rehabilitation.In the motor function, the post-stroke patients with a moderate impairment level who have voluntary movement of the whole upper limb or upper limb except for the wrist are most likely to receive these therapeutic effects.
Collapse
Affiliation(s)
- Takatoshi Hara
- Department of Rehabilitaion Medicine, The Jikei University School of Medicine, Minato, Japan
| | - Masachika Niimi
- Department of Rehabilitaion Medicine, The Jikei University School of Medicine, Minato, Japan
| | - Naoki Yamada
- Department of Rehabilitaion Medicine, The Jikei University School of Medicine, Minato, Japan
| | - Yusuke Shimamoto
- Department of Rehabilitaion Medicine, Kikyougahara Hospital, Nagano, Japan
| | - Go Masuda
- Department of Rehabilitaion Medicine, Kyoto Ohara Memorial Hospital, Kyoto, Japan
| | - Hiroyoshi Hara
- Department of Rehabilitaion Medicine, Isawa Kyoritsu Hospital, Yamanashi, Japan
| | - Masahiro Abo
- Department of Rehabilitaion Medicine, The Jikei University School of Medicine, Minato, Japan
| |
Collapse
|
5
|
Benavides J, Castro OE. Validation of a semiological maneuver for the evaluation of spastic dynamic clubfoot: an approach based on the judgment of experts in physical medicine and rehabilitation. Eur J Phys Rehabil Med 2022; 58:575-583. [PMID: 35191656 PMCID: PMC9980492 DOI: 10.23736/s1973-9087.22.07355-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The evaluation of spasticity of the plantar flexors in dynamic clubfoot is difficult due to the almost invariable concomitance of Achilles clonus, which is a semiological artifact. No description was found in the literature of a technique for inhibiting or reducing the discharge generated by Achilles clonus to allow a correct assessment of spasticity in this segment. AIM Validation of a semiological maneuver that reduces or eliminates Achilles clonus for the adequate evaluation of spastic dynamic clubfoot. DESIGN Multicenter cross-sectional study. SETTING The study was conducted by 12 experts in physical medicine and rehabilitation from various clinics and hospitals in Colombia. POPULATION Thirty-five adults with dynamic spastic clubfoot and Achilles clonus secondary to upper motor neuron syndrome who attended outpatient consultation at physical medicine and rehabilitation services in eight cities Colombia from August 2020 to February 2021. METHODS The usual method for examining spastic plantar flexors was compared to the proposed semiological maneuver to evaluate the proposed maneuver contributed to the reduction or elimination of Achilles clonus to allow a more accurate measure of spasticity in this segment. Four dimensions were evaluated by the experts: time required for application, simplicity, effectiveness and clinical utility. A cutoff point was established to identify whether the maneuver was unacceptable, acceptable or excellent. RESULTS The application of the maneuver was able to reduce or eliminate Achilles clonus as a masking sign of spasticity in the plantar flexors in 100% of the patients and was considered excellent in 77.1% of the cases for the four dimensions evaluated. A decrease in the degree of spasticity of the plantar flexors was observed when the maneuver was applied. CONCLUSIONS The proposed maneuver reduces or eliminates Achilles clonus, which could allow a more precise evaluation of spasticity in this segment. All of the experts recommended including the maneuver in routine examinations of this population. CLINICAL REHABILITATION IMPACT Applying the proposed maneuver could improve the selection of patients with spastic dynamic clubfoot who require specific treatment.
Collapse
Affiliation(s)
- Javier Benavides
- Department of Physical Medicine and Rehabilitation, University of Valle, Cali, Colombia -
| | - Oscar E Castro
- Department of Physical Medicine and Rehabilitation, University of Valle, Cali, Colombia
| |
Collapse
|
6
|
Tabaie SA, Videckis AJ, Quan T, Sheppard ED. Topical Review: Approach to Diagnosis and Management of the Pediatric Foot and Ankle in Cerebral Palsy Patients. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221091800. [PMID: 35479332 PMCID: PMC9036346 DOI: 10.1177/24730114221091800] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sean A. Tabaie
- Division of Orthopaedic Surgery and Sports Medicine, Children’s National Hospital, Washington, DC, USA
| | | | - Theodore Quan
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Evan D. Sheppard
- Division of Orthopaedic Surgery and Sports Medicine, Children’s National Hospital, Washington, DC, USA
| |
Collapse
|
7
|
Fooladvand F, Tahouri V, Baeeri M, Minaei T, Rahimifard M, Hodjat M, Khorasani R, Haghi-Aminjan H, Abdollahi M. Toxic potential of botulinum toxin type A on senescence in a Drosophila melanogaster model. Toxicol Rep 2021; 8:1576-1582. [PMID: 34458104 PMCID: PMC8379625 DOI: 10.1016/j.toxrep.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/28/2021] [Accepted: 08/13/2021] [Indexed: 10/31/2022] Open
Abstract
Botulinum toxin type-A (BoNT/A) application, especially neurological disorders, has been spread nowadays while it may cause side effects. The current study aimed to assess the BoNT/A dose-dependent effect on induction of aging in the Drosophila melanogaster model. The third instar larvae of Drosophila melanogaster were exposed to ¼ LC50, ½ LC50, and LC50 of BoNT/A in the Drosophila diet for 48 h while H2O2 1% was used as a positive control. After the exposure time, some larvae were collected for molecular study, including gene expression analysis, comet assay, oxidative stress markers, and the phenotype changes. BoNT/A induced dose-dependent cytotoxicity, elevated reactive oxygen species (ROS) levels, and superoxide dismutase (SOD) enzyme activity. In addition, it caused DNA damage and activated caspase-3 and -9, and reduced the body size of the fly, especially in high doses. In line with the purpose of the study, aging markers, including β-galactosidase (β-gal), p16, p21, p38, and p53, were up-regulated by BoNT/A low dose. BoNT/A activates the aging pathway in the low dose, and increasing the dose induces toxicity, including oxidative stress, DNA damage, and apoptosis.
Collapse
Affiliation(s)
- Farnoosh Fooladvand
- Pharmaceutical Sciences Branch, Islamic Azad University, Tehran, Iran.,Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Vida Tahouri
- Pharmaceutical Sciences Branch, Islamic Azad University, Tehran, Iran.,Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Maryam Baeeri
- Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Tayebeh Minaei
- Department of Cell and Molecular Biology, School of Biology, College of Science, University of Tehran, Tehran, Iran
| | - Mahban Rahimifard
- Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mahshid Hodjat
- Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Reza Khorasani
- Department of Toxicology and Pharmacology, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Haghi-Aminjan
- Pharmaceutical Sciences Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mohammad Abdollahi
- Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Department of Toxicology and Pharmacology, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
8
|
Hung JW, Chen YW, Chen YJ, Pong YP, Wu WC, Chang KC, Wu CY. The Effects of Distributed vs. Condensed Schedule for Robot-Assisted Training with Botulinum Toxin A Injection for Spastic Upper Limbs in Chronic Post-Stroke Subjects. Toxins (Basel) 2021; 13:toxins13080539. [PMID: 34437410 PMCID: PMC8402581 DOI: 10.3390/toxins13080539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/14/2021] [Accepted: 07/29/2021] [Indexed: 11/16/2022] Open
Abstract
Robot-assisted training (RT) combined with a Botulinum toxin A (BoNT-A) injection has been suggested as a means to optimize spasticity treatment outcomes. The optimal schedule of applying RT after a BoNT-A injection has not been defined. This single-blind, randomized controlled trial compared the effects of two predefined RT approaches as an adjunct to BoNT-A injections of spastic upper limbs in chronic post-stroke subjects. Thirty-six patients received a BoNT-A injection in the affected upper extremity and were randomly assigned to the condensed or distributed RT group. The condensed group received an intervention of four sessions/week for six consecutive weeks. The distributed group attended two sessions/week for 12 consecutive weeks. Each session included 45 min of RT using the InMotion 2.0 robot, followed by 30 min of functional training. The Fugl-Meyer Assessment, Modified Ashworth Scale, Wolf Motor Function Test, Motor Activity Log, and Stroke Self-Efficacy Questionnaire were assessed at pre-training, mid-term, post-training, and at 6 week follow-up, with the exception of the Motor Activity Log, which did not include mid-term measures. After the intervention, both groups had significant improvements in all outcome measures (within-group effects, p < 0.05), with the exception of the Wolf Motor Function Test time score. There were no significant differences between groups and interaction effects in all outcome measures. Our findings suggest that RT provided in a fixed dosage as an adjunct to a BoNT-A injection has a positive effect on participants' impairment and activity levels, regardless of treatment frequency. (ClinicalTrials.gov: NCT03321097).
Collapse
Affiliation(s)
- Jen-Wen Hung
- Department of Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan; (J.-W.H.); (Y.-J.C.); (Y.-P.P.); (W.-C.W.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
| | - Yen-Wei Chen
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Taoyuan 33302, Taiwan;
- Healthy Aging Research Center, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yi-Ju Chen
- Department of Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan; (J.-W.H.); (Y.-J.C.); (Y.-P.P.); (W.-C.W.)
| | - Ya-Ping Pong
- Department of Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan; (J.-W.H.); (Y.-J.C.); (Y.-P.P.); (W.-C.W.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
| | - Wen-Chi Wu
- Department of Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan; (J.-W.H.); (Y.-J.C.); (Y.-P.P.); (W.-C.W.)
| | - Ku-Chou Chang
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
- Division of Cerebrovascular Diseases, Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan
| | - Ching-Yi Wu
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Taoyuan 33302, Taiwan;
- Healthy Aging Research Center, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan
- Correspondence:
| |
Collapse
|
9
|
Loushin SR, Coleman Wood KA, Kaufman KR. Method for characterization of dynamic ankle stiffness in patients with spasticity. Gait Posture 2021; 88:247-251. [PMID: 34130093 DOI: 10.1016/j.gaitpost.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/06/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Dynamic ankle stiffness has been quantified as the slope of the ankle joint moment-angle curve over the gait interval of the second rocker, defined explicitly as the period of the gait cycle from the first relative maximum plantar flexion in early stance to maximum dorsiflexion in midstance. However, gastrocnemius spasticity may interfere with the second ankle rocker in patients with spasticity. This gait disruption results in stiffness calculations which are misleading. Current dynamic stiffness metrics need to be modified. RESEARCH QUESTION The main goal of this study was to develop and test a new method to better evaluate dynamic ankle stiffness in individuals with pathologic gait who lack a second rocker interval. METHODS Twenty unimpaired ambulators (10/20 female, 26.7 ± 5.0 years, BMI: 23.2 ± 2.2) and 9 individuals with cerebral palsy (5/9 female, 5.7 ± 1.7 years, BMI: 14.6 ± 2.1, GMFCS Levels: I - 2, II - 5, III - 2) participated in this study. Dynamic ankle stiffness was evaluated using the previous kinematic method, defined by the interval of maximum plantar flexion to maximum dorsiflexion angle in midstance, and the proposed kinetic method, defined by the interval from the maximum dorsiflexion moment to first peak plantar flexion moment. Stiffness was quantified as the linear slope between the sagittal plane ankle angle and moment. Method differences were explored using an equivalence test (α = 0.05). RESULTS AND SIGNIFICANCE There was equivalence between the methods for unimpaired ambulators (p = 0.000) and a lack of equivalence for patients with spasticity (p = 0.958). The new method was successfully applied to all 9 pediatric ambulators with CP and demonstrated increased stiffness in patients with spasticity as compared to the previous method. The ability to objectively calculate ankle stiffness in pathologic gait is critical for determining change associated with clinical intervention.
Collapse
Affiliation(s)
- Stacy R Loushin
- Motion Analysis Laboratory, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Krista A Coleman Wood
- Motion Analysis Laboratory, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Kenton R Kaufman
- Motion Analysis Laboratory, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| |
Collapse
|
10
|
Fehlings D, Krishnan P, Ragguett R, deVeber G, Gorter JW, Hunt C, Kim M, Mesterman R, McCormick A. Neurodevelopmental profiles of children with unilateral cerebral palsy associated with middle cerebral artery and periventricular venous infarctions. Dev Med Child Neurol 2021; 63:729-735. [PMID: 33521966 PMCID: PMC8247945 DOI: 10.1111/dmcn.14818] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2020] [Indexed: 11/29/2022]
Abstract
AIM To compare the neurodevelopment of children with unilateral cerebral palsy (CP) with middle cerebral artery (MCA) and periventricular venous infarctions (PVIs). METHOD In this cross-sectional study, children with unilateral CP completed a neurological exam, unimanual Quality of Upper Extremity Skills Test, hand usage questionnaires, and IQ test. Neuroimaging was obtained from health records. RESULTS Two hundred and forty-five participants with unilateral CP had neuroimaging (151 [61.9%] male, ages 2-18y, median=7y 6mo, interquartile range [IQR]=6y 7mo, with 93.6% in Gross Motor Function Classification System level I/II and 78.8% in Manual Ability Classification System level I/II). Ninety-seven (39.6%) had MCA injuries and 106 (43.3%) had periventricular white matter injuries, of which 48 (45.3%) were PVIs. Median Quality of Upper Extremity Skills Test for the MCA group was 49.2 (IQR=55.8), PVI 79.9 (IQR=23.6) (Mann-Whitney U=988.50, p<0.001). Bimanual hand usage (Children's Hand-use Experience Questionnaire) (Mann-Whitney U=425, p<0.001) and light touch (odds ratio=9.12, 95% confidence interval 1.28-400.76, Fisher's exact test p=0.017) were lower in the MCA compared to the PVI group. Full-scale IQ median centile score for the MCA group was 18.0 (IQR=35.5) and 50.0 (IQR=30.0) for the PVI group (Mann-Whitney U=382, p<0.001). INTERPRETATION Children with unilateral CP and MCA injuries demonstrated lower hand function and usage, decreased light touch, and lower IQs compared to the PVI group. This study aids in defining rehabilitation needs informed by brain injury patterns.
Collapse
Affiliation(s)
- Darcy Fehlings
- Department of PaediatricsBloorview Research InstituteHolland Bloorview Kids Rehabilitation HospitalUniversity of TorontoTorontoONCanada
| | - Pradeep Krishnan
- Department of Diagnostic ImagingThe Hospital for Sick ChildrenUniversity of TorontoTorontoONCanada
| | - Renee‐Marie Ragguett
- Department of PaediatricsBloorview Research InstituteHolland Bloorview Kids Rehabilitation HospitalUniversity of TorontoTorontoONCanada
| | - Gabrielle deVeber
- Department of PaediatricsThe Hospital for Sick ChildrenUniversity of TorontoTorontoONCanada
| | - Jan Willem Gorter
- Department of PediatricsCanChildMcMaster Children's HospitalMcMaster UniversityHamiltonONCanada
| | - Carolyn Hunt
- Department of PaediatricsGrandview Children's CentreUniversity of TorontoTorontoONCanada
| | - Marie Kim
- Erinoak Kids Center for Treatment and DevelopmentMississaugaONCanada
| | - Ronit Mesterman
- Department of PediatricsCanChildMcMaster Children's HospitalMcMaster UniversityHamiltonONCanada
| | - Anna McCormick
- Department of Pediatricsthe Children's Hospital of Eastern Ontario (CHEO)OttawaONCanada
| | | |
Collapse
|
11
|
Abstract
BACKGROUND A common aesthetic concern among East Asian women is enlarged calves. Although surgical resection has been a traditional treatment option, botulinum toxin injections into the gastrocnemius muscle are an emerging, noninvasive alternative. OBJECTIVE To perform a literature review on botulinum toxin injections for leg contouring. MATERIALS AND METHODS A literature review was conducted using PubMed, Web of Science, Embase, and Cochrane's CENTRAL database to identify articles relating to combinations of the terms botulinum toxin, gastrocnemius, calves, and leg contouring. RESULTS Based on the limited publications to date, the authors prepared a review on how to treat an enlarged calf with botulinum toxin including injection techniques, anticipated efficacy, outcome monitoring, and potential side effects. CONCLUSION Botulinum toxin injections for calf reduction are an emerging, noninvasive treatment option. Studies to date suggest that it is an efficacious method with few immediate side effects. Future areas for investigation include defining the criteria for calf hypertrophy, minimum effective dosage of botulinum toxin, and the potential long-term effects of injections.
Collapse
|
12
|
MacFarlane C, Orr R, Hing W. Sensomotoric Orthoses, Ankle-Foot Orthoses, and Children with Cerebral Palsy: The Bigger Picture. CHILDREN-BASEL 2020; 7:children7080082. [PMID: 32722251 PMCID: PMC7465417 DOI: 10.3390/children7080082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/01/2020] [Accepted: 07/20/2020] [Indexed: 11/16/2022]
Abstract
Ankle-foot orthoses (AFOs) and sensomotoric orthoses (SMotOs) are two-clinically relevant, yet under researched-types of lower limb orthoses used in children with cerebral palsy (CP). Quality of life is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Evaluating the effect of these two types of orthoses on quality of life in children with CP has not been reported on. The aim of this case study series was to synthesise and enrich the volume of evidence reported to inform real world applications of SMotO use in children with CP. Participants recruited were children with CP who performed the Berg Balance Scale, Timed Up-and-Go, the Gross Motor Function Measure and/or the Edinburgh Visual Gait Score in AFOs, SMotOs and barefoot where able. Qualitative data included videos of gait, a questionnaire and pedographs. Eight participants completed 39 quantitative and six qualitative measures, with the Edinburgh Visual Gait Score (EVGS) reporting the highest response. A general improvement was seen in gross motor skills and gait when wearing the SMotOs compared to AFOs and some parents reported that SMotOs were preferred. The reader is able to correlate the quantitative results with the qualitative evidence presented.
Collapse
|
13
|
Milne N, Miao M, Beattie E. The effects of serial casting on lower limb function for children with Cerebral Palsy: a systematic review with meta-analysis. BMC Pediatr 2020; 20:324. [PMID: 32615954 PMCID: PMC7330971 DOI: 10.1186/s12887-020-02122-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 05/05/2020] [Indexed: 11/10/2022] Open
Abstract
Background Lower limb serial casting is commonly used therapeutically in paediatric clinical practice with some evidence to support its efficacy. This systematic review aimed to determine the effects of serial casting in isolation or combination with other therapies for the management of lower limb dysfunction in children with Cerebral Palsy (CP). Methods A systematic literature search was conducted in February 2019 across eight databases (PUBMED, EMBASE, CINAHL, PEDro, OTSeeker, Cochrane, Scopus and Proquest) using key terms ‘Cerebral Palsy’ and ‘serial casting’ and associated synonyms. A meta-synthesis and meta-analysis were undertaken when sufficient results were available showing the effect of serial casting on functional outcomes including: Ankle range of motion; neurological measures of hypertonicity and spasticity, functional gait measures and; gross motor function. Results Twenty-five articles from 3219 possible citations were included. Serial casting was found to be effective for: Improving ankle dorsiflexion (DF) passive range of motion (PROM) in the immediate to short-term, decreasing hypertonicity measured by Modified Ashworth Scale (MAS) in the short-term and, enhancing functional gait outcomes in the mid-term. Serial casting with or without botulinum toxin type-A (BTX-A) did not significantly affect gross motor capacity measured by Gross Motor Function Measure (GMFM). Serial casting with pharmacological intervention achieved significantly more DF PROM than serial casting alone (MD − 3.19 degrees; 95% CI − 5.76 to − 0.62; P = 0.01; I2 = 0%), however the clinical importance of improving ankle DF PROM by an additional three degrees remains unclear. Conclusions Lower limb serial casting, improves several outcomes relevant to lower limb function supporting its clinical use for improving DF PROM, reducing hypertonicity and improving gait in children with CP. Further research using stronger methodological study designs, is indicated to explore long-term effects of serial casting on functional lower limb outcomes such as gross motor function in children with CP. Clinicians can use this information when developing individualised treatment plans for children who have CP during shared decision-making consultations.
Collapse
Affiliation(s)
- Nikki Milne
- Physiotherapy Program, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, 4229, Australia. .,Department of Physiotherapy, Bond Institute of Health and Sport, Bond University, Gold Coast, Australia.
| | - Michelle Miao
- Physiotherapy Program, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, 4229, Australia
| | - Emma Beattie
- Physiotherapy Program, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, 4229, Australia
| |
Collapse
|
14
|
Rajagopal A, Kidziński Ł, McGlaughlin AS, Hicks JL, Delp SL, Schwartz MH. Pre-operative gastrocnemius lengths in gait predict outcomes following gastrocnemius lengthening surgery in children with cerebral palsy. PLoS One 2020; 15:e0233706. [PMID: 32502157 PMCID: PMC7274436 DOI: 10.1371/journal.pone.0233706] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 05/11/2020] [Indexed: 11/19/2022] Open
Abstract
Equinus deformity is one of the most common gait deformities in children with cerebral palsy. We examined whether estimates of gastrocnemius length in gait could identify limbs likely to have short-term and long-term improvements in ankle kinematics following gastrocnemius lengthening surgery to correct equinus. We retrospectively analyzed data of 891 limbs that underwent a single-event multi-level surgery (SEMLS), and categorized outcomes based on the normalcy of ankle kinematics. Limbs with short gastrocnemius lengths that received a gastrocnemius lengthening surgery as part of a SEMLS (case limbs) were 2.2 times more likely than overtreated limbs (i.e., limbs who did not have short lengths, but still received a lengthening surgery) to have a good surgical outcome at the follow-up gait visit (good outcome rate of 71% vs. 33%). Case limbs were 1.2 times more likely than control limbs (i.e., limbs that had short gastrocnemius lengths but no lengthening surgery) to have a good outcome (71% vs. 59%). Three-fourths of the case limbs with a good outcome at the follow-up gait visit maintained this outcome over time, compared to only one-half of the overtreated limbs. Our results caution against over-prescription of gastrocnemius lengthening surgery and suggest gastrocnemius lengths can be used to identify good surgical candidates.
Collapse
Affiliation(s)
- Apoorva Rajagopal
- Department of Mechanical Engineering, Stanford University, Stanford, CA, United States of America
| | - Łukasz Kidziński
- Department of Bioengineering, Stanford University, Stanford, CA, United States of America
| | - Alec S. McGlaughlin
- Department of Bioengineering, Stanford University, Stanford, CA, United States of America
| | - Jennifer L. Hicks
- Department of Bioengineering, Stanford University, Stanford, CA, United States of America
| | - Scott L. Delp
- Department of Mechanical Engineering, Stanford University, Stanford, CA, United States of America
- Department of Bioengineering, Stanford University, Stanford, CA, United States of America
| | - Michael H. Schwartz
- Center for Gait and Motion Analysis, Gillette Children’s Specialty Healthcare, St. Paul, MN, United States of America
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, United States of America
| |
Collapse
|
15
|
MacFarlane C, Hing W, Orr R. Using the Edinburgh Visual Gait Score to Compare Ankle-Foot Orthoses, Sensorimotor Orthoses and Barefoot Gait Pattern in Children with Cerebral Palsy. CHILDREN-BASEL 2020; 7:children7060054. [PMID: 32492892 PMCID: PMC7346128 DOI: 10.3390/children7060054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/31/2020] [Accepted: 05/28/2020] [Indexed: 11/16/2022]
Abstract
Gait analysis is one aspect of evaluation in ambulatory children with cerebral palsy (CP). Ankle-foot orthoses (AFOs) improve gait and alignment through providing support. An alternative and under-researched orthosis are sensomotoric orthoses (SMotOs). The Edinburgh Visual Gait Score (EVGS) is a valid observational gait analysis scale to measure gait quality. The aim of this study was to use the EVGS to determine what effect AFOs and SMotOs have on gait in children with CP. The inclusion criteria were: mobilizing children with a CP diagnosis, no surgery in the past six weeks, and currently using SMotOs and AFOs. Eleven participants were videoed walking 5 m (any order) barefoot, in SMotOs and AFOs. Of the participants (age range 3-13 years, mean 5.5 ± 2.9), two were female and six used assistive devices. Seven could walk barefoot. Participants had spastic diplegia (4), spastic quadriplegia (6), and spastic dystonic quadriplegia (1). Gross Motor Functional Classification System (GMFCS) levels ranged I-IV. The total score for SMotOs (7.62) and AFOs (14.18) demonstrated improved gait when wearing SMotOs (no significant differences between barefoot and AFOs). SMotOs may be a viable option to improve gait in this population. Additional study is required but SMotOs may be useful in clinical settings.
Collapse
|
16
|
Valentine J, Davidson SA, Bear N, Blair E, Paterson L, Ward R, Forbes D, Elliott C. A prospective study investigating gross motor function of children with cerebral palsy and GMFCS level II after long-term Botulinum toxin type A use. BMC Pediatr 2020; 20:7. [PMID: 31906902 PMCID: PMC6945782 DOI: 10.1186/s12887-019-1906-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 12/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study is to contribute to the knowledge base on the long-term outcomes of evidence-based medical interventions used to improve gross motor function in children and adolescents with Cerebral Palsy. METHOD Prospective cohort study of children with Cerebral Palsy in the birth years 2000-2009 attending a tertiary level service for children with Cerebral Palsy who's first recorded Gross Motor Function Classification System level was II. RESULTS A total of 40 children were eligible for the study, of whom 28 (72.7%) enrolled. The Botulinum toxin A treatment for this cohort, (median and interquartile ranges) were: total number of lower limb Botulinum toxin A injections 11 (6.7, 5.5); total dose of Botulinum Toxin A per lower limb treatment 6.95 u/kg (4.5, 11); and dose of Botulinum Toxin u/kg/muscle 2.95 (2.2, 4). For all 28 subjects there was a median of 15 (8.5 to 22) Gross Motor Function Classification System level recordings: six of the 28 children (21.4%) improved from level II to level I, the remaining 22 children remained stable at level II (78.6%). In this highly treated population, the average 66 item Gross Motor Function Measure score for the 22 children in level II was 72.55, which is consistent with the mean of 68.5 reported in the original Ontario cohort. CONCLUSION This cohort study has confirmed that children with Cerebral Palsy, Gross Motor Function level II treated at a young age with repeated doses of Botulinum Toxin A within an integrated comprehensive service, maintain or improve their functional motor level at a later age.
Collapse
Affiliation(s)
- Jane Valentine
- School of Medicine, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia. .,Department of Paediatric Rehabilitation, Perth Children's Hospital, Nedlands, Western Australia, Australia.
| | - Sue-Anne Davidson
- Department of Paediatric Rehabilitation, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Natasha Bear
- Department of Child Research, Child Adolescent Health Service, Nedlands, Western Australia, Australia
| | - Eve Blair
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Lisa Paterson
- Department of Paediatric Rehabilitation, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Roslyn Ward
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Bentley, Western Australia, Australia
| | - David Forbes
- School of Medicine, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
| | - Catherine Elliott
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Bentley, Western Australia, Australia
| |
Collapse
|
17
|
Hara T, Momosaki R, Niimi M, Yamada N, Hara H, Abo M. Botulinum Toxin Therapy Combined with Rehabilitation for Stroke: A Systematic Review of Effect on Motor Function. Toxins (Basel) 2019; 11:toxins11120707. [PMID: 31817426 PMCID: PMC6950173 DOI: 10.3390/toxins11120707] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/29/2019] [Accepted: 12/03/2019] [Indexed: 11/16/2022] Open
Abstract
Aim: The purpose of this study was to examine the effectiveness of botulinum toxin A (BoNT-A) therapy combined with rehabilitation on motor function in post-stroke patients. Methods: The following sources up to December 31, 2018, were searched from inception for articles in English: Pubmed, Scopus, CINAHL, Embase, PsycINFO, and CENTRAL. Trials using injections of BoNT-A for upper and lower limb rehabilitation were examined. We excluded studies that were not performed for rehabilitation or were not evaluated for motor function. Results: Twenty-six studies were included. In addition to rehabilitation, nine studies used adjuvant treatment to improve spasticity or improve motor function. In the upper limbs, two of 14 articles indicated that significant improvement in upper limb motor function was observed compared to the control group. In the lower limbs, seven of 14 articles indicated that significant improvement in lower limb motor function was observed compared to the control group. Conclusions: The effect of combined with rehabilitation is limited after stroke, and there is not sufficient evidence, but results suggest that BoNT-A may help to improve motor function. In future studies, the establishment of optimal rehabilitation and evaluation times of BoNT-A treatment will be necessary for improving motor function and spasticity.
Collapse
Affiliation(s)
- Takatoshi Hara
- Department of Rehabilitation Medicine The Jikei University School of Medicine 3-25-8, Nishi-Shinbashi, Minato-Ku, Tokyo 105-8461, Japan
- Correspondence: ; Tel.: +81-3-3433-1111; Fax: +81-3-3431-1206
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Teikyo University School of Medicine University Hospital, Mizonokuchi, Kanagawa 213-8507, Japan
| | - Masachika Niimi
- Department of Rehabilitation Medicine The Jikei University School of Medicine 3-25-8, Nishi-Shinbashi, Minato-Ku, Tokyo 105-8461, Japan
| | - Naoki Yamada
- Department of Rehabilitation Medicine The Jikei University School of Medicine 3-25-8, Nishi-Shinbashi, Minato-Ku, Tokyo 105-8461, Japan
| | - Hiroyoshi Hara
- Rehabilitation Center, Ainomiyako Neurosurgery Hospital, Osaka 538-0044, Japan
| | - Masahiro Abo
- Department of Rehabilitation Medicine The Jikei University School of Medicine 3-25-8, Nishi-Shinbashi, Minato-Ku, Tokyo 105-8461, Japan
| |
Collapse
|
18
|
Kimoto M, Yonetsu R, Okada K, Horioka W, Kondou T, Sasaki M, Sakamoto H. Effect of home-based training focused on increasing maximum step length in walking function of children with cerebral palsy. PHYSICAL THERAPY REVIEWS 2019. [DOI: 10.1080/10833196.2019.1664083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Minoru Kimoto
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
- Department of Medicine, Akita Prefectural Center on Development and Disability, Akita, Japan
| | - Ryo Yonetsu
- Faculty of Rehabilitation, School of Health Sciences, Kanagawa University of Human Services, Yokosuka, Japan
| | - Kyoji Okada
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | - Wataru Horioka
- Department of Medicine, Akita Prefectural Center on Development and Disability, Akita, Japan
| | - Takanori Kondou
- Department of Rehabilitation, Akita Prefectural Center for Rehabilitation and Psychiatric Medicine, Daisen, Japan
| | - Makoto Sasaki
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | - Hitoshi Sakamoto
- Department of Medicine, Akita Prefectural Center on Development and Disability, Akita, Japan
| |
Collapse
|
19
|
Valentine J, Davidson SA, Bear N, Blair E, Ward R, Thornton A, Stannage K, Watson L, Forbes D, Elliott C. Botulinum toxin and surgical intervention in children and adolescents with cerebral palsy: who, when and why do we treat? Disabil Rehabil 2019; 43:936-943. [PMID: 31415723 DOI: 10.1080/09638288.2019.1644381] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION This audit aimed to increase understanding of the long-term outcomes of evidence-based medical and surgical interventions to improve gross motor function in children and adolescents with Cerebral Palsy. METHODS Retrospective audit of a birth cohort (2000-2009) attending a tertiary service in Western Australia. RESULTS The cohort comprises 771 patients aged 8 to 17 years. Percentage of children receiving no Botulinum Toxin treatments in each Gross Motor Functional Classification System level was: I: 40%, II: 26%, III: 33%, IV: 28% and V: 46%. Of the total cohort, 53% of children received 4 or less Botulinum Toxin treatments and 3.7% received more than 20 treatments. Statistically significant difference in the rate of use of Botulinum Toxin pre and post-surgery (p < 0.001) was documented. Children levels IV and V had 5 times the odds of surgery compared to children levels I-III (Odds Ratio 5.2, 95% Confidence Interval 3.5 to 7.8, p < 0.001). For 578 (75%) of participants the last recorded level was the same as the first. CONCLUSION This audit documents medical intervention by age and Gross Motor Functional Classification System level in a large cohort of children with cerebral palsy over time and confirms stability of the level in the majority.IMPLICATIONS FOR REHABILITATIONThe information from this audit may be of use in discussions with families regarding the timing and use of Botulinum toxin and surgical intervention for motor function in children and adolescents with Cerebral Palsy.Long term use of Botulinum Toxin within an integrated evidence-based clinical program is not associated with loss of gross motor function in the long term as evidenced by the maintenance of Gross Motor Functional Classification System stability.
Collapse
Affiliation(s)
- Jane Valentine
- School of Medicine University of Western Australia, Perth, Australia
| | - Sue-Anne Davidson
- Department of Paediatric Rehabilitation, Perth Children's Hospital, Perth, Australia
| | - Natasha Bear
- Department of Child Research, Child Adolescent Health Service, Perth, Australia
| | - Eve Blair
- Telethon Kids Institute, Perth, Australia
| | - Roslyn Ward
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Ashleigh Thornton
- School of Medicine University of Western Australia, Perth, Australia
| | - Katherine Stannage
- Department of Orthopaedic Surgery, Perth Children's Hospital, Perth, Australia
| | - Linda Watson
- WA Register of Developmental Anomalies, King Edward Memorial Hospital, Subiaco, Australia
| | | | - Catherine Elliott
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| |
Collapse
|
20
|
Kelly B, MacKay-Lyons M, Berryman S, Hyndman J, Wood E. Casting Protocols Following BoNT-A Injections to Treat Spastic Hypertonia of the Triceps Surae in Children with Cerebral Palsy and Equinus Gait: A Randomized Controlled Trial. Phys Occup Ther Pediatr 2019; 39:77-93. [PMID: 29771161 DOI: 10.1080/01942638.2018.1471015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AIM To study the effects of single versus serial casting post-Botulinum toxin A (BoNT-A) injections on hypoextensibility of triceps surae in children, 2-7 years old, with cerebral palsy and equinus gait. METHODS A randomized, stratified, parallel, two-group trial was conducted at a pediatric health center with assessments at baseline, precast, postcast and, 1-, 2-, and 6-month follow-ups. One week following BoNT-A injections into triceps surae muscle, a single below-knee cast (n = 10) or 3 serial casts (n = 10) were applied for 3 weeks. Primary outcome measure was the Modified Tardieu Scale (MTS), secondary outcome measures were Modified Ashworth Scale (MAS), GAITRite™, Gross Motor Function Measure-66 (GMFM-66), and Pediatric Evaluation of Disability Inventory (PEDI). RESULTS Significant effects of time, but not group-by-time, were found for MTS R1 (P < 0.001), MTS R2 (P < 0.001), MAS (P = 0.001), GMFM-66 (P = 0.002), and PEDI (P < 0.001-0.009). One participant who received a single cast did not complete the 6-month assessment. CONCLUSIONS Magnitudes of improvements were similar using single or serial casting. If these findings are corroborated in a larger scale study, the recommendation of a single cast may be appropriate due to its greater convenience for families and clinicians.
Collapse
Affiliation(s)
- Barbara Kelly
- a School of Physiotherapy , Dalhousie University , Halifax, Nova Scotia , Canada and IWK Health Centre Halifax , Nova Scotia , Canada
| | - Marilyn MacKay-Lyons
- b School of Physiotherapy , Dalhousie University , Halifax, Nova Scotia , Canada
| | | | - Joe Hyndman
- d IWK Health Centre and Faculty of Medicine , Dalhousie University , Halifax, Nova Scotia , Canada
| | - Ellen Wood
- d IWK Health Centre and Faculty of Medicine , Dalhousie University , Halifax, Nova Scotia , Canada
| |
Collapse
|
21
|
Fonseca Jr. PR, Calhes Franco de Moura R, Galli M, Santos Oliveira C. Effect of physiotherapeutic intervention on the gait after the application of botulinum toxin in children with cerebral palsy: systematic review. Eur J Phys Rehabil Med 2018; 54:757-765. [DOI: 10.23736/s1973-9087.17.04940-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
22
|
Hara T, Abo M, Hara H, Sasaki N, Yamada N, Niimi M, Shimamoto Y. The Effect of Repeated Botulinum Toxin A Therapy Combined with Intensive Rehabilitation on Lower Limb Spasticity in Post-Stroke Patients. Toxins (Basel) 2018; 10:toxins10090349. [PMID: 30200281 PMCID: PMC6162421 DOI: 10.3390/toxins10090349] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 08/28/2018] [Accepted: 08/30/2018] [Indexed: 11/29/2022] Open
Abstract
Objectives: This study is a retrospective investigation of the effects of repetitive botulinum toxin A therapy (BoNT-A) and intensive rehabilitation (IR) on lower limb spasticity in post-stroke patients. Methods: Thirty-five post-stroke patients was included in this study and received BoNT-A for the first time. A 12-day inpatient protocol was with 4 cycles of the treatment protocol. The severity of spasticity, motor function and brace status were evaluated. Results: The modified Ashworth Scale (MAS) score of ankle dorsiflexors, range of motion, walking speed and balancing ability were significantly improved after cycle 1. The improvement of spasticity and motor function was persistent through cycles 2–4. One-third of brace users were able to discontinue the use of a brace. All of these brace users showed a forward gait pattern prior to therapy. Conclusions: Repeated BoNT-A combined with IR improved lower limb spasticity in post-stroke patients. Our results suggest that patients who show the forward gait pattern prior to therapy may be able to discontinue the use of their brace after therapy.
Collapse
Affiliation(s)
- Takatoshi Hara
- Department of Rehabilitaion Medicine, The Jikei University School of Medicine, 1058461 Tokyo, Japan.
- Department of Rehabilitaion Medicine, Kikyogahara Hospital 1295, 3996461 Nagano, Japan.
| | - Masahiro Abo
- Department of Rehabilitaion Medicine, The Jikei University School of Medicine, 1058461 Tokyo, Japan.
| | - Hiroyoshi Hara
- Department of Rehabilitaion Medicine, Kikyogahara Hospital 1295, 3996461 Nagano, Japan.
| | - Nobuyuki Sasaki
- Department of Rehabilitaion Medicine, The Jikei University School of Medicine, 1058461 Tokyo, Japan.
| | - Naoki Yamada
- Department of Rehabilitaion Medicine, The Jikei University School of Medicine, 1058461 Tokyo, Japan.
| | - Masachika Niimi
- Department of Rehabilitaion Medicine, The Jikei University School of Medicine, 1058461 Tokyo, Japan.
| | - Yusuke Shimamoto
- Department of Rehabilitaion Medicine, Kikyogahara Hospital 1295, 3996461 Nagano, Japan.
| |
Collapse
|
23
|
Abstract
PURPOSE OF REVIEW The review provides an update on the treatment of hypertonia in cerebral palsy, including physical management, pharmacotherapy, neurosurgical, and orthopedic procedures. RECENT FINDINGS Serial casting potentiates the effect of Botulinum neurotoxin A injections for spasticity. Deep brain stimulation, intraventricular baclofen, and ventral and dorsal rhizotomy are emerging tools for the treatment of dystonia and/or mixed tone. The long-term results of selective dorsal rhizotomy and the timing of orthopedic surgery represent recent advances in the surgical management of hypertonia. SUMMARY Management of hypertonia in cerebral palsy targets the functional goals of the patient and caregiver. Treatment options are conceptualized as surgical or nonsurgical, focal or generalized, and reversible or irreversible. The role of pharmacologic therapies is to improve function and mitigate adverse effects. Further investigation, including clinical trials, is required to determine the role of deep brain stimulation, intraventricular baclofen, orthopedic procedures for dystonia, and rhizotomy.
Collapse
|
24
|
Read FA, Boyd RN, Barber LA. Longitudinal assessment of gait quality in children with bilateral cerebral palsy following repeated lower limb intramuscular Botulinum toxin-A injections. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 68:35-41. [PMID: 28735160 DOI: 10.1016/j.ridd.2017.07.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/28/2017] [Accepted: 07/02/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Serial lower limb intramuscular Botulinum toxin-A (BoNT-A) injections are administered to children with bilateral spastic cerebral palsy (BCP) to reduce spasticity, improve walking and functional mobility, and delay the need for orthopaedic surgery. Gait quality is clinically assessed following BoNT-A with 2D video gait assessments (2DVGA) using the Edinburgh Visual Gait Score (EVGS). AIM To determine the effect of three consecutive treatment cycles of lower limb intramuscular BoNT-A injections on gait quality using the EVGS in children with BCP by retrospectively reviewing repeated 2DVGA measures. METHODS AND PROCEDURES Seventeen children with BCP and dynamic equinus (8 females and 9 males, age mean (SD), 4.0 (2.2) years, GMFCS I=2 and II=15) were included in the study after a retrospective audit of the records of the Queensland Children's Gait Laboratory (QCGL), Children's Health Queensland, Brisbane. The medical records of children who attended the QCGL between January 2001 and January 2016 were searched for eligibility. Children who had undertaken pre- and post-treatment 2DVGA for the first three lower limb BoNT-A treatment cycles (6 assessments) were reviewed using the EVGS. BoNT-A treatments were administered 7.7 (2.3) months apart and post-BoNT-A reviews occurred 12.6 (6.7) weeks after injection. Mixed-effects linear regression assessed the change from baseline to each subsequent assessment (p<0.05). OUTCOMES AND RESULTS EVGS reduced significantly by a mean of 2.4 points from pre- to post-BoNT-A in the first treatment cycle (p=0.001). Compared to baseline, mean total EVGS reduced significantly during the second (pre-BoNT-A -1.7 (p=0.020), post BoNT-A -2.8 (p<0.001)) and third (pre-BoNT-A -2.6 (p=0.001), post BoNT-A -2.4 (p=0.002)) treatment cycles. There was no difference in EVGS between post-BoNT-A in the first treatment cycle and scores for the second and third treatment cycles. CONCLUSIONS AND IMPLICATIONS Improvements in gait quality were statistically significant, but did not reach the EVGS smallest real difference value of 4 points. Repeated lower limb intramuscular BoNT-A injections to improve gait quality in children with BCP should be reconsidered.
Collapse
Affiliation(s)
- Felicity A Read
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Australia.
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Australia
| | - Lee A Barber
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Australia
| |
Collapse
|
25
|
Nieuwenhuys A, Papageorgiou E, Pataky T, De Laet T, Molenaers G, Desloovere K. Literature Review and Comparison of Two Statistical Methods to Evaluate the Effect of Botulinum Toxin Treatment on Gait in Children with Cerebral Palsy. PLoS One 2016; 11:e0152697. [PMID: 27030973 PMCID: PMC4816309 DOI: 10.1371/journal.pone.0152697] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 03/17/2016] [Indexed: 11/19/2022] Open
Abstract
AIM This study aimed at comparing two statistical approaches to analyze the effect of Botulinum Toxin A (BTX-A) treatment on gait in children with a diagnosis of spastic cerebral palsy (CP), based on three-dimensional gait analysis (3DGA) data. Through a literature review, the available expert knowledge on gait changes after BTX-A treatment in children with CP is summarized. METHODS Part 1--Intervention studies on BTX-A treatment in children with CP between 4-18 years that used 3DGA data as an outcome measure and were written in English, were identified through a broad systematic literature search. Reported kinematic and kinetic gait features were extracted from the identified studies. Part 2--A retrospective sample of 53 children with CP (6.1 ± 2.3years, GMFCS I-III) received 3DGA before and after multilevel BTX-A injections. The effect of BTX-A on gait was interpreted by comparing the results of paired samples t-tests on the kinematic gait features that were identified from literature to the results of statistical parametric mapping analysis on the kinematic waveforms of the lower limb joints. RESULTS Part 1-53 kinematic and 33 kinetic features were described in literature. Overall, there is no consensus on which features should be evaluated after BTX-A treatment as 49 features were reported only once or twice. Part 2--Post-BTX-A, both statistical approaches found increased ankle dorsiflexion throughout the gait cycle. Statistical parametric mapping analyses additionally found increased knee extension during terminal stance. In turn, feature analyses found increased outtoeing during stance after BTX-A. CONCLUSION This study confirms that BTX-A injections are a valuable treatment option to improve gait function in children with CP. However, different statistical approaches may lead to different interpretations of treatment outcome. We suggest that a clear, definite hypothesis should be stated a priori and a commensurate statistical approach should accompany this hypothesis.
Collapse
Affiliation(s)
- Angela Nieuwenhuys
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
- * E-mail:
| | - Eirini Papageorgiou
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
| | - Todd Pataky
- Department of Bioengineering, Shinshu University, Ueda, Japan
| | - Tinne De Laet
- Faculty of Engineering Science, KU Leuven, Leuven, Belgium
| | - Guy Molenaers
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Orthopedics, University Hospitals Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
26
|
Choi JY, Jung S, Rha DW, Park ES. Botulinum Toxin Type A Injection for Spastic Equinovarus Foot in Children with Spastic Cerebral Palsy: Effects on Gait and Foot Pressure Distribution. Yonsei Med J 2016; 57:496-504. [PMID: 26847306 PMCID: PMC4740546 DOI: 10.3349/ymj.2016.57.2.496] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/09/2015] [Accepted: 08/06/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To investigate the effect of intramuscular Botulinum toxin type A (BoNT-A) injection on gait and dynamic foot pressure distribution in children with spastic cerebral palsy (CP) with dynamic equinovarus foot. MATERIALS AND METHODS Twenty-five legs of 25 children with CP were investigated in this study. BoNT-A was injected into the gastrocnemius (GCM) and tibialis posterior (TP) muscles under the guidance of ultrasonography. The effects of the toxin were clinically assessed using the modified Ashworth scale (MAS) and modified Tardieu scale (MTS), and a computerized gait analysis and dynamic foot pressure measurements using the F-scan system were also performed before injection and at 1 and 4 months after injection. RESULTS Spasticity of the ankle plantar-flexor in both the MAS and MTS was significantly reduced at both 1 and 4 months after injection. On dynamic foot pressure measurements, the center of pressure index and coronal index, which represent the asymmetrical weight-bearing of the medial and lateral columns of the foot, significantly improved at both 1 and 4 months after injection. The dynamic foot pressure index, total contact area, contact length and hind foot contact width all increased at 1 month after injection, suggesting better heel contact. Ankle kinematic data were significantly improved at both 1 and 4 months after injection, and ankle power generation was significantly increased at 4 months after injection compared to baseline data. CONCLUSION Using a computerized gait analysis and foot scan, this study revealed significant benefits of BoNT-A injection into the GCM and TP muscles for dynamic equinovarus foot in children with spastic CP.
Collapse
Affiliation(s)
- Ja Young Choi
- Department of Rehabilitation Medicine, Severance Hospital, Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Soojin Jung
- Department of Rehabilitation Medicine, Severance Hospital, Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Wook Rha
- Department of Rehabilitation Medicine, Severance Hospital, Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Sook Park
- Department of Rehabilitation Medicine, Severance Hospital, Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea.
| |
Collapse
|
27
|
Valentine J, Stannage K, Fabian V, Ellis K, Reid S, Pitcher C, Elliott C. Muscle histopathology in children with spastic cerebral palsy receiving botulinum toxin type A. Muscle Nerve 2016; 53:407-14. [PMID: 26154631 DOI: 10.1002/mus.24763] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 06/19/2015] [Accepted: 07/06/2015] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Botulinum toxin A (BoNTA) is routine treatment for hypertonicity in children with cerebral palsy (CP). METHODS This single-blind, prospective, cross-sectional study of 10 participants (mean age 11 years 7 months) was done to determine the relationship between muscle histopathology and BoNTA in treated medial gastrocnemius muscle of children with CP. Open muscle biopsies were taken from medial gastrocnemius muscle and vastus lateralis (control) during orthopedic surgery. RESULTS Neurogenic atrophy in the medial gastrocnemius was seen in 6 participants between 4 months and 3 years post-BoNTA. Type 1 fiber loss with type 2 fiber predominance was significantly related to the number of BoNTA injections (r = 0.89, P < 0.001). CONCLUSIONS The impact of these changes in muscle morphology on muscle function in CP is not clear. It is important to consider rotating muscle selection or injection sites within the muscle or allowing longer time between injections.
Collapse
Affiliation(s)
- Jane Valentine
- Department of Paediatric Rehabilitation, Princess Margaret Hospital, Perth, Western Australia, Australia.,School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - Katherine Stannage
- Department of Orthopedic Surgery, Princess Margaret Hospital, Perth, Western Australia, Australia
| | - Vicki Fabian
- Neuropathology Section, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Kevin Ellis
- Neuropathology Section, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Siobhan Reid
- School of Sport Science, Exercise & Health, University of Western Australia, Perth, Western Australia, Australia
| | - Christian Pitcher
- School of Sport Science, Exercise & Health, University of Western Australia, Perth, Western Australia, Australia
| | - Catherine Elliott
- Department of Paediatric Rehabilitation, Princess Margaret Hospital, Perth, Western Australia, Australia.,Faculty of Health Science, Curtin University, Perth, Western Australia, Australia
| |
Collapse
|
28
|
García Salazar LF, dos Santos GL, Pavão SL, Rocha NACF, de Russo TL. Intrinsic properties and functional changes in spastic muscle after application of BTX-A in children with cerebral palsy: systematic review. Dev Neurorehabil 2015; 18:1-14. [PMID: 25180438 DOI: 10.3109/17518423.2014.948640] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This article aimed to review the literature to verify the effect of botulinum toxin type A (BTX-A) on the intrinsic properties of spastic muscles and functionality in children with cerebral palsy (CP). METHODS A literature search was conducted in the following databases: CINAHL, SCOPUS, Web of Science and PubMed. Database searches were limited to the period from January 1993 to March 2014. RESULTS A total of 2182 papers were identified, and 17 met the inclusion criteria. Only one study analyzed the effect of the toxin on muscle intrinsic properties and others analyzed the effect on functionality. CONCLUSION BTX-A application demonstrated no changes in the passive stiffness of spastic muscle. In relation to functional level, the evidence of BTX-A effect was controversial. These studies showed methodological quality limitations that restrict the interpretation of the results for the entire CP population, which justifies the need for further randomized controlled trials.
Collapse
Affiliation(s)
- Luisa Fernanda García Salazar
- Department of Physical Therapy, Laboratory of Neurological Physiotherapy Research, Federal University of São Carlos (UFSCar) , São Carlos, SP , Brazil and
| | | | | | | | | |
Collapse
|
29
|
Novak AC, Olney SJ, Bagg S, Brouwer B. Gait Changes Following Botulinum Toxin A Treatment in Stroke. Top Stroke Rehabil 2015; 16:367-76. [DOI: 10.1310/tsr1605-367] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
30
|
Singer B, Dunnet J, Allison G. Clinical Evaluation of Hypertonia in the Triceps Surae Muscles. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/108331901786161582] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
31
|
Chan J, Winter A, Palit M, Sturt R, Graaff SD, Holland AE. Are gait and mobility measures responsive to change following botulinum toxin injections in adults with lower limb spasticity? Disabil Rehabil 2012; 35:959-67. [PMID: 23025332 DOI: 10.3109/09638288.2012.717579] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To determine whether gait and mobility measures are responsive to change following botulinum toxin (BoNT) injections in adults with lower limb spasticity. METHOD Independently ambulant adults who attended a spasticity clinic for lower limb BoNT injections were eligible to participate. The 10 m walk test (shoes on and off), timed up and go test and 6-min walk test were performed before injection and 1 month later. Participants completed a global rating of change scale (GRCS) at follow up. Comparisons were made between participants' ratings of change and change in walking performance. Effect sizes (ES) and standard error of measurement (SEM) were calculated for each outcome. RESULTS Thirty-nine patients (22 female, 17 male; mean age 51 ± 12 years; range 26-74 years) with a median spasticity duration of 53 months participated. Statistically significant changes were found in all gait and mobility measures at 1 month following injection. All ES were small (<0.2) and SEM for each measure was large. The global rating of change scale (GRCS) indicated that 66% of participants perceived that their walking had improved. However, there was a significant relationship between GRCS and performance on walking tests for the 10 m walk test with shoes off (p = 0.01) and timed up and go test (p = 0.02) only. CONCLUSION Commonly used walking tests may not be responsive to change following BoNT injection. The small ES suggest that BoNT has a modest effect on walking ability. Tests of walking performance may not be sufficient to capture all clinically relevant changes in walking ability following BoNT injection of the lower limb.
Collapse
Affiliation(s)
- Joyce Chan
- School of Physiotherapy, La Trobe University, Bundoora 3068, Australia
| | | | | | | | | | | |
Collapse
|
32
|
Lee SJ, Sung IY, Jang DH, Yi JH, Lee JH, Ryu JS. The effect and complication of botulinum toxin type a injection with serial casting for the treatment of spastic equinus foot. Ann Rehabil Med 2011; 35:344-53. [PMID: 22506143 PMCID: PMC3309222 DOI: 10.5535/arm.2011.35.3.344] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 12/11/2010] [Indexed: 12/01/2022] Open
Abstract
Objective To identify the effect of serial casting combined with Botulinum toxin type A (BTX-A) injection on spastic equinus foot. Method Twenty-nine children with cerebral palsy who had equinus foot were recruited from the outpatient clinic of Rehabilitation Medicine. The children were divided into 2 groups, one of which received serial casting after BTX-A injection, and the other which only received BTX-A injection. Serial casting started 3 weeks after the BTX-A injection, and was changed weekly for 3 times. Spasticity of the ankle joint was evaluated using the modified Ashworth scale (MAS), and the modified Tardieu scale (MTS). Gait pattern was measured using the physician's rating scale (PRS). Results The degree of ankle dorsiflexion and the MAS improved significantly until 12 weeks following the BTX-A injection in the serial casting group (p<0.001), while the BTX-A injection-only group improved until 6 weeks following injection (p<0.05). The combined group showed a significantly greater increase in the degree of dorsiflexion compared to the BTX-A injection-only group at post-injection weeks 6 and 12 (p<0.05). Three children (11.5%) suffered from foot ulcers as a complication caused by the serial casting. Conclusion Our study demonstrated that the effect of BTX-A injection with serial casting was superior and lasted longer than the effect of BTX-A injection only in patients with spastic equinus foot. We therefore recommend BTX-A injection with serial casting for the treatment of equinus foot. However, physicians must also consider the possible complications associated with serial casting.
Collapse
Affiliation(s)
- Sook Joung Lee
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | | | | | | | | | | |
Collapse
|
33
|
Botulinum toxin type A injections for treatment of spastic equinus in cerebral palsy: a secondary analysis of factors predictive of favorable response. Am J Phys Med Rehabil 2010; 89:865-72. [PMID: 20736816 DOI: 10.1097/phm.0b013e3181f1c5e7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate markers predicting favorable botulinum toxin injection outcomes in treating spastic equinus gait in children with cerebral palsy. DESIGN Thirty-six children (21 boys and 15 girls, aged 1.5-9.6 yrs; 20 with unilateral and 16 with bilateral cerebral palsy levels I to IV with the Gross Motor Function Classification System) with 49 treated lower limbs were included. Passive range of movement, selective dorsiflexion, dynamic muscle length (modified Tardieu Scale), calf tone (modified Ashworth Scale), attainment of anticipated gait pattern (Goal Attainment Scale), and video gait analysis (Observational Gait Scale) were assessed before and 1, 2, and 4 mos after intervention. Participants were classified as poor or good responders, according to the Goal Attainment Scale response at 2 mos. RESULTS Good response was noted in 23 (64%) children and 29 (59%) legs, whereas 13 (36%) children and 20 (41%) legs were defined as poor responders. In a multivariate regression analysis, the best predictors of good response per child were higher initial Observational Gait Scale total scores, one-level treatment, and normal cognition; and the best predictors per leg were good initial selective motor control in the ankle and capability of occasional flatfoot contact at pretreatment. CONCLUSIONS These results suggest that children with less severe functional deficit, fair to good selective motor control in the ankle, and mild equinus gait respond best to focal botulinum toxin type A treatment, with an eye to flatfoot or heel strike contact. Likewise, children with higher cognitive level seem to derive functional benefit from the treatment.
Collapse
|
34
|
Abstract
Clinical decision making for the management of foot deformities in children with cerebral palsy is based on the collection and integration of data from 5 sources: the clinical history, physical examination, plain radiographs, observational gait analysis, and quantitative gait analysis (which includes kinematic/kinetic analyses, dynamic electromyography, and dynamic pedobarography). The 3 most common foot segmental malalignments in children with CP are equinus, equinoplanovalgus, and equinocavovarus. The 2 most common associated deformities are ankle valgus and hallux valgus. Foot and ankle deformities caused by dynamic overactivity and imbalance of muscles are best treated with pharmacologic or neurosurgical interventions designed to manage muscle tone and spasticity, or muscle tendon unit transfers. Deformities caused by fixed or myostatic soft tissue imbalance without fixed skeletal malalignment are best treated with muscle tendon unit lengthening surgery. Deformities characterized by structural skeletal malalignment associated with fixed or myostatic soft tissue imbalance are best treated with a combination of soft tissue and skeletal surgeries.
Collapse
Affiliation(s)
- Jon R Davids
- Motion Analysis Laboratory, Shriners Hospital for Children, Greenville, SC 29605, USA.
| |
Collapse
|
35
|
Hayek S, Gershon A, Wientroub S, Yizhar Z. The effect of injections of botulinum toxin type A combined with casting on the equinus gait of children with cerebral palsy. ACTA ACUST UNITED AC 2010; 92:1152-9. [PMID: 20675764 DOI: 10.1302/0301-620x.92b8.23086] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Our aim was to evaluate the effect of adding inhibitory casting to the treatment of young children with cerebral palsy who received injections of botulinum neurotoxin A (BoNT-A) to gastrocnemius for equinus gait. Of the 20 patients in the series, 11 in group A had inhibitory casts applied on the day of the first set of BoNT-A injections and nine in group B did not have casting. Both groups received another BoNT-A injection four months later. The patients were followed for eight months and examined at five intervals. Both groups showed significant improvement in gait parameters and function (p < 0.0001) and selective motor control (p = 0.041, - 0.036) throughout the study. Group A had significantly better passive dorsiflexion of the ankle (p = 0.029), observational gait score (p = 0.006) and selective motor control (p = 0.036). We conclude that the addition of inhibitory casting enhances and prolongs the results of treatment and mainly influences the passive range of movement, while BoNT-A mostly influences the dynamic motion. The second injection further improved the results of most parameters. The gross motor function measure, the selective motor control test and the modified Tardieu scale correlated well with the results of treatment. We recommend the use of inhibitory casting whenever augmentation of the effect of treatment with BoNT-A is needed.
Collapse
Affiliation(s)
- S Hayek
- Department of Paediatric Orthopaedics, Dana Children's Hospital, Tel Aviv Medical Centre, 6 Weizmann Street, Tel Aviv 64239, Israel.
| | | | | | | |
Collapse
|
36
|
Molenaers G, Van Campenhout A, Fagard K, De Cat J, Desloovere K. The use of botulinum toxin A in children with cerebral palsy, with a focus on the lower limb. J Child Orthop 2010; 4:183-95. [PMID: 21629371 PMCID: PMC2866843 DOI: 10.1007/s11832-010-0246-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Accepted: 02/12/2010] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The purpose of this review is to clarify the role of botulinum toxin serotype A (BTX-A) in the treatment of children with cerebral palsy (CP), with a special focus on the lower limb. BACKGROUND The treatment of spasticity is central in the clinical management of children with CP. BTX-A blocks the release of acetylcholine at the motor end plate, causing a temporary muscular denervation and, in an indirect way, a reduced spasticity. Children with increased tone develop secondary problems over time, such as muscle contractures and bony deformities, which impair their function and which need orthopaedic surgery. However in these younger children, delaying surgery is crucial because the results of early surgical interventions are less predictable and have a higher risk of failure and relapse. As BTX-A treatment reduces tone in a selective way, it allows a better motor control and muscle balance across joints, resulting in an improved range of motion and potential to strengthen antagonist muscles, when started at a young age. The effects are even more obvious when the correct BTX-A application is combined with other conservative therapies, such as physiotherapy, orthotic management and casts. There is now clear evidence that the consequences of persistent increased muscle tone can be limited by applying an integrated multi-level BTX-A treatment approach. Nevertheless, important challenges such as patient selection, defining appropriate individual goals, timing, dosing and dilution, accuracy of injection technique and how to measure outcomes will be questioned. Therefore, "reflection is more important than injection" remains an actual statement.
Collapse
Affiliation(s)
- Guy Molenaers
- />Department of Paediatric Orthopaedics, University Hospital Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium
- />Musculoskeletal Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Anja Van Campenhout
- />Department of Paediatric Orthopaedics, University Hospital Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium
- />Musculoskeletal Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Katrien Fagard
- />Clinical Motion Analysis Laboratory, University Hospital Pellenberg, Pellenberg, Belgium
| | - Jos De Cat
- />Clinical Motion Analysis Laboratory, University Hospital Pellenberg, Pellenberg, Belgium
| | - Kaat Desloovere
- />Clinical Motion Analysis Laboratory, University Hospital Pellenberg, Pellenberg, Belgium
- />Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| |
Collapse
|
37
|
Molenaers G, Schörkhuber V, Fagard K, Van Campenhout A, De Cat J, Pauwels P, Ortibus E, De Cock P, Desloovere K. Long-term use of botulinum toxin type A in children with cerebral palsy: treatment consistency. Eur J Paediatr Neurol 2009; 13:421-9. [PMID: 18977158 DOI: 10.1016/j.ejpn.2008.07.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Revised: 07/10/2008] [Accepted: 07/14/2008] [Indexed: 11/26/2022]
Abstract
At the University Hospital of Pellenberg (Belgium), more than 1000 patients have been treated with Botulinum toxin type A (BTX-A) over the last decade. Ten percent of these patients (n=106) received multiple (at least four times), multi-level, high-dosage treatments. The aim of this study was to evaluate the stability of dosage and treatment intervals in long-term, multi-level, high-dosage treated children with cerebral palsy and to evaluate the evidence for a safe and stable response to this treatment. Data on disease, age, dosage and target muscles were extracted for each treatment session of 106 patients who received multiple BTX-A treatment sessions. Patients had a follow-up of 4y 6mo (range 1y 8mo-8y 9mo) on average and received 4 to 12 BTX-A treatments within the period of January 1996 and December 2005. Patients received a mean dosage of 23.5+/-5.2U/kgbw at first treatment with stable subsequent values. Mean dosages for children with diplegia, hemiplegia and quadriplegia were 24.5+/-4.7U/kgbw, 15.9+/-3.7U/kgbw and 22.0+/-4.8U/kgbw, respectively. Mean age at first treatment was 4y 6mo (range 1y 11mo-18y 10mo) with a majority of patients (76.4%) first treated within 2 and 4y of age. Treatment intervals of approximately 1y remained stable within four, five and six subsequent treatments. Long-term, high-dosage, multi-level BTX-A applications can be considered as a safe and stable treatment option for children with cerebral palsy and the formation of antibodies, responsible for secondary non-response, can be indirectly precluded.
Collapse
Affiliation(s)
- Guy Molenaers
- Department of Paediatric Orthopaedics, UZ Pellenberg, Belgium; Musculoskeletal Sciences, KU-Leuven, Belgium
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Lofterød B, Fosdahl MA, Terjesen T. Can persistent drop foot after calf muscle lengthening be predicted preoperatively? J Foot Ankle Surg 2009; 48:631-6. [PMID: 19857817 DOI: 10.1053/j.jfas.2009.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Indexed: 02/03/2023]
Abstract
UNLABELLED Calf muscle lengthening usually corrects equinus gait satisfactorily in stance. While in swing, the foot remains in drop foot in approximately half the limbs. The aim of this study was to evaluate if any preoperative clinical findings or kinematic and kinetic data could predict the outcome regarding drop foot. The study included 34 children with cerebral palsy. The average age was 9.3 years. Only children with preoperative maximum ankle dorsiflexion in stance and maximum ankle dorsiflexion in swing more than 2 standard deviations below the normal mean were included. The children underwent preoperative and postoperative clinical examination and gait analysis. Forty calf muscle lengthenings were performed (26 tendo-achilles lengthenings, 14 gastrocnemius recessions). Nineteen of 40 limbs remained in drop foot despite satisfactory correction in stance. There was a significant association between postoperative drop foot and increased preoperative maximum plantar flexion in initial swing (P = .004; odds ratio, 0.906). A limited number of tests of preoperative selective motor control of dorsiflexion of the ankle indicated that normal function is strongly indicative of postoperative normal swing phase. There were no significant associations between postoperative drop foot and preoperative clinical findings, gait function, type of gait pattern, type of cerebral palsy, and type of operation. Preoperative maximum plantar flexion in an initial swing of less than -42 degrees and a preoperative normal selective motor control of dorsiflexion of the ankle are strongly indicative of postoperative normal swing phase. A lower selective motor control score rather than normal function is not predictive of either normal swing or drop foot. LEVEL OF EVIDENCE 2.
Collapse
Affiliation(s)
- Bjørn Lofterød
- Section for Child Neurology, Department of Paediatrics, Rikshospitalet University Hospital, Sognsvannsveien 20, Oslo, Norway.
| | | | | |
Collapse
|
39
|
Lukban MB, Rosales RL, Dressler D. Effectiveness of botulinum toxin A for upper and lower limb spasticity in children with cerebral palsy: a summary of evidence. J Neural Transm (Vienna) 2009; 116:319-31. [PMID: 19142573 DOI: 10.1007/s00702-008-0175-8] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2008] [Accepted: 12/11/2008] [Indexed: 10/21/2022]
|
40
|
Power generation in children with spastic hemiplegic cerebral palsy. Gait Posture 2008; 27:641-7. [PMID: 17951060 DOI: 10.1016/j.gaitpost.2007.08.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Revised: 08/15/2007] [Accepted: 08/22/2007] [Indexed: 02/02/2023]
Abstract
BACKGROUND Spastic hemiplegic cerebral palsy is a challenging disorder often affecting children with high functional and cognitive level, who are good candidates for physiotherapy treatment, including co-ordination and muscle strengthening exercises. The goal of this study was to investigate hip and ankle power generation on both the hemiplegic and uninvolved sides in children with spastic hemiplegic cerebral palsy and no previous surgery. METHODS Ninety-nine patients with spastic hemiplegic CP with a mean age of 8.4 years were included. Medical records and gait analysis data were reviewed. Patients were classified using Winter's criteria and an independent sample t-test was used to compare groups. RESULTS The hip extensor power generation was higher in all Winter classification groups on both the hemiplegic and uninvolved sides, compared to age matched normal subjects. Comparing the power generation at the ankle, all groups had less power generation on both the hemiplegic and non-involved side. CONCLUSIONS We found a major power generation shift from the ankle to the hips in children with spastic hemiplegic cerebral palsy both on the hemiplegic and the uninvolved sides. This could be interpreted, as a way of compensating for decreased ankle power generation on the hemiplegic side. The results may suggest that muscle strengthening physiotherapy should be directed toward the hip power generators and co-ordination exercises should be focused distally to the knee and ankle. This may also suggest that power loss at the ankle, such as after tendon-Achilles lengthening, may be of less importance.
Collapse
|
41
|
Blackmore AM, Boettcher-Hunt E, Jordan M, Chan MDY. A systematic review of the effects of casting on equinus in children with cerebral palsy: an evidence report of the AACPDM. Dev Med Child Neurol 2007; 49:781-90. [PMID: 17880650 DOI: 10.1111/j.1469-8749.2007.00781.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This systematic review examines the effects of casting, either alone or in combination with botulinum toxin type A (BTX-A), on equinus in children with cerebral palsy (CP). Comparisons are made between casting alone and no treatment, between casting alone and BTX-A alone, between combined casting and BTX-A and each treatment by itself, and between casting followed by BTX-A and BTX-A followed by casting. A search of PUBMED, CINAHL, Proquest Health and Medical Complete, Cochrane Database of Systematic reviews, Physiotherapy Evidence Database (PEDro), OTseeker, Database of Reviews of Effectiveness (DARE), and Infotrieve yielded 184 citations. Articles were included in the review if they reported the effects of an intervention using casting for equinus in particpants with CP aged 20 or less, if they appeared in a peer-reviewed scholarly journal in 1970 or later, with no language restriction, and if casting was not used in conjunction with surgery. Twenty-two articles were selected, including seven randomized controlled trials (RCTs). There is little evidence that casting is superior to no casting, but the protocols of casting in current use have not been compared with no treatment in any RCT. There is no strong and consistent evidence that combining casting and BTX-A is superior to using either intervention alone, or that either casting or BTX-A is superior to the other immediately after treatment. Finally, there is no evidence that order of treatment (casting before BTX-A versus BTX-A before casting) affects outcome. Much of the evidence both for and against differences is weak, and results may be explained by methodological limitations. Future research needs to use adequate sample sizes, long-term follow-ups, and broader and more global measures.
Collapse
Affiliation(s)
- A M Blackmore
- The Centre for Cerebral Palsy, Mount Lawley, Western Australia, Australia.
| | | | | | | |
Collapse
|
42
|
Galli M, Cimolin V, Valente EM, Crivellini M, Ialongo T, Albertini G. Computerized gait analysis of Botulinum Toxin treatment in children with cerebral palsy. Disabil Rehabil 2007; 29:659-64. [PMID: 17453987 DOI: 10.1080/09638280600948136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Intramuscular botulinum toxin A (BTA) injection is a local reversible treatment with a wide range of therapeutic applications, including temporary reduction of spasticity. The aim of this work was a quantitative, computerized objective evaluation of BTA-induced improvement of the walking functional ability in a group of children with cerebral palsy (CP). METHODS Fifteen children with CP and 20 healthy children were evaluated. All patients were equinus walkers without fixed contractures of triceps surae muscles and they were evaluated before and after about 1.5 months from BTA injections into the calf muscles. The effectiveness of treatment was evaluated by 3D computerized gait analysis. RESULTS Data analysis revealed a significant improvement of equinus foot and ankle range of motion during gait after BTA injection. Positive effects were evident also at the knee joint as documented by the improvement of kinetics characteristics (moment and power). CONCLUSIONS Computerized gait analysis is a valid method for quantification of BTA effect on walking in children with CP, allowing a detailed evaluation of improvement at each joint and a quantitative evaluation of treatment outcome.
Collapse
Affiliation(s)
- Manuela Galli
- Dipartimento di Bioingegneria, Politecnico di Milano, Milano, Italy.
| | | | | | | | | | | |
Collapse
|
43
|
Haugh AB, Pandyan AD, Johnson GR. A systematic review of the Tardieu Scale for the measurement of spasticity. Disabil Rehabil 2006; 28:899-907. [PMID: 16861197 DOI: 10.1080/09638280500404305] [Citation(s) in RCA: 163] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The Tardieu Scale has been suggested a more appropriate clinical measure of spasticity than the Ashworth or modified Ashworth Scales. It appears to adhere more closely to Lance's definition of spasticity as it involves assessment of resistance to passive movement at both slow and fast speeds. OBJECTIVE To review the available literature in which the Tardieu Scale has been used or discussed as a measure of spasticity, with a view to determining its validity and reliability. STUDY DESIGN A systematic review of all literature found related to the Tardieu Scale (keywords: Tardieu scale, spasticity) from Pubmed and Ovid databases, including medline, CINAHL, EMBASE, Journals at Ovid full text, EBM reviews and Cochrane database of systematic reviews. Hand searching was also used to track the source literature. CONCLUSIONS In theory, we can acknowledge that the Tardieu Scale does, in fact, adhere more closely to Lance's definition of spasticity. However, there is a dearth of literature investigating validity and reliability of the scale. Some studies have identified the Tardieu Scale to be more sensitive than other measures, to change following treatment with botulinum toxin. Further studies need to be undertaken to clarify the validity and reliability of the scale for a variety of muscle groups in adult neurological patients.
Collapse
Affiliation(s)
- A B Haugh
- Centre for Rehabilitation and Engineering Studies (CREST), University of Newcastle upon Tyne, UK.
| | | | | |
Collapse
|
44
|
Dickens WE, Smith MF. Validation of a visual gait assessment scale for children with hemiplegic cerebral palsy. Gait Posture 2006; 23:78-82. [PMID: 16311198 DOI: 10.1016/j.gaitpost.2004.12.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2004] [Indexed: 02/02/2023]
Abstract
This study reports the experience of reliability testing and validation of a visual assessment of gait based on the Physician Rating Scale in children with hemiplegic cerebral palsy. Comparison with three-dimensional gait analysis showed excellent correlation between observers and full gait analysis for sagittal plane motion at the knee in stance. Inter and intra-rater reliability showed moderate to almost perfect agreement for foot contact characteristics and ankle in stance. Use of this scale may be helpful in assessment of children where frequent analysis of these characteristics is needed.
Collapse
Affiliation(s)
- Wendy E Dickens
- The Gait Analysis Laboratory, The Ryegate Children's Centre, The Sheffield Children's Hospital NHS Trust, Tapton Crescent Road, Sheffield S105DD, UK
| | | |
Collapse
|
45
|
Sätilä H, Iisalo T, Pietikäinen T, Seppänen RL, Salo M, Koivikko M, Autti-Rämö I, Haataja R. Botulinum toxin treatment of spastic equinus in cerebral palsy: a randomized trial comparing two injection sites. Am J Phys Med Rehabil 2005; 84:355-65; quiz 366-7, 392. [PMID: 15829782 DOI: 10.1097/01.phm.0000160006.51859.ae] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore the clinical relevance of injection site by comparing two different injection techniques in children with cerebral palsy who have spastic equinus gait. DESIGN A total of 19 children (13 boys, 6 girls; range, 1 yr 6 mos to 7 yrs; nine hemiplegics, eight diplegics, two quadriplegics; levels I to IV with the Gross Motor Function Classification System) participated in the study. The children were randomized into two groups: the proximal group received a botulinum toxin A injection into the proximal part of both heads of the gastrocnemius, and the distal group received a botulinum toxin A injection into the mid-belly of the muscle bulks. A single-point injection of BOTOX, 3 units/kg per site, was used. Assessments of active and passive range of motion, dynamic muscle length (modified Tardieu scale), calf tone (modified Ashworth scale), and video gait analysis (Observational Gait Scale) were performed before treatment and 3, 8, and 16 wks posttreatment. RESULTS Active and passive dorsiflexion and calf tone in both groups and Observational Gait Scale total scores in the distal group improved at all time points. The median change from baseline values in Observational Gait Scale initial foot contact and total scores at 8 wks showed a significant difference favoring the distal group, but the clinical relevance remained tenuous. CONCLUSIONS Using the methods described, no major changes in main outcome measures were associated with changing the injection site.
Collapse
Affiliation(s)
- Heli Sätilä
- Department of Paediatric Neurology, Tampere University Hospital, Tampere, Finland
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Ylvisaker M, Adelson PD, Braga LW, Burnett SM, Glang A, Feeney T, Moore W, Rumney P, Todis B. Rehabilitation and ongoing support after pediatric TBI: twenty years of progress. J Head Trauma Rehabil 2005; 20:95-109. [PMID: 15668573 DOI: 10.1097/00001199-200501000-00009] [Citation(s) in RCA: 153] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article summarizes major developments of the past 20 years in both acute and chronic management of children with traumatic brain injury. The article begins with brief summaries of developments in acute and rehabilitative medical management and physical rehabilitation. Because long-term cognitive, behavioral, academic, and family issues tend to be dominant after pediatric TBI, more attention is given to these topics. The article ends with a list of general themes that have been identified as critical in providing effective long-term services and supports to children with TBI and their families.
Collapse
Affiliation(s)
- Mark Ylvisaker
- School of Education, College of Saint Rose, Albany, NY, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Zwick EB, Leistritz L, Milleit B, Saraph V, Zwick G, Galicki M, Witte H, Steinwender G. Classification of equinus in ambulatory children with cerebral palsy-discrimination between dynamic tightness and fixed contracture. Gait Posture 2004; 20:273-9. [PMID: 15531174 DOI: 10.1016/j.gaitpost.2003.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2003] [Revised: 08/28/2003] [Accepted: 10/15/2003] [Indexed: 02/02/2023]
Abstract
In this study a generalised dynamic neural network (GDNN) was designed to process gait analysis parameters to evaluate equinus deformity in ambulatory children with cerebral palsy. The aim was to differentiate dynamic calf muscle tightness from fixed muscle contracture. Patients underwent clinical examination and had instrumented gait analysis before evaluating their equinus under anaesthesia and muscle relaxation at the time of surgery to improve gait. The performance of the clinical examination, the subjective interpretation of gait analysis results, and the application of the neural network to assess ankle function were compared to the examination under anaesthesia. Evaluation of equinus by a Neural Network showed high sensitivity and specificity values with a likelihood ratio of +14.63. The results indicate that dynamic calf muscle tightness can be differentiated from fixed calf muscle contracture with considerable precision that might facilitate clinical decision-making.
Collapse
Affiliation(s)
- Ernst B Zwick
- Department of Paediatric Surgery, Paediatric Orthopaedic Unit, Karl Franzens University, Auenbruggerplatz 34, A-8036 Graz, Austria.
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Molenaers G, Desloovere K, De Cat J. Botulinumtoxin A bei der Behandlung der infantilen Zerebralparese. DER ORTHOPADE 2004; 33:1119-28. [PMID: 15278274 DOI: 10.1007/s00132-004-0688-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Botulinum toxin A represents a significant development in the management of children and adolescents with spastic cerebral palsy. Prerequisites for an adequate result are a correct indication, an exact injection technique and an intensive post-treatment programme. Spastic muscle overactivity and the constant tendency of the involved muscles to shorten with growth cannot be treated by only one method. Therefore a multilevel approach and an integrated treatment schedule including plaster of Paris, orthoses and physiotherapy are currently the best ways to modify the disease process. The inclusion of objective clinical documentation techniques combined with 3-D instrumented gait analysis allows the determination of the indications more exactly and for monitoring the post-treatment results. If started early and correctly, this integrated management approach has the potential to modify the natural history of the disorder, and to reduce the frequency of later surgery.
Collapse
Affiliation(s)
- G Molenaers
- Heelkunde-Orthopedie, University Hospital Pellenburg, Weligerveld 1, 3212 Pellenburg, Belgium.
| | | | | |
Collapse
|
49
|
Abstract
Information is presented on the current state of administering botulinum toxin A injections in the pediatric population based on review of scientific publications cited in MEDLINE and PubMed that involved the use of botulinum toxin A in patients under the age of 19. Studies were selected if they contained nearly complete information on botulinum toxin dosing and injection technique within the article. In addition, consensus articles from pediatric task forces were selected for review. Information regarding botulinum toxin A dosing and injection technique was gathered from the material and method sections of the selected studies or from tables in consensus articles. Information was collected in regard to the total amount of botulinum toxin used, commercial brand of botulinum toxin used, dilution of the toxin, volume of toxin preparation, needle size, localization technique, adverse reactions, and whether sedation was used. There is currently a range of dosing and injections techniques in the literature when using botulinum toxin A in children. Body weight, muscle size, location of muscle, and degree of spasticity are all considered to determine total amount of botulinum toxin injected. Concentration and volume of the diluted toxin can affect the amount of spread of the toxin after injection. Injection techniques also vary and are not well reported. Use of electromyographic, electrical stimulation, or ultrasound guidance is employed in children for difficult to locate individual muscle groups. Use of sedation also varies between medical centers.
Collapse
Affiliation(s)
- Douglas Kinnett
- Division of Pediatric Rehabilitation, Departments of Pediatrics and Physical Medicine and Rehabilitation, The Cincinnati Children's Hospital Medical Center and University of Cincinnati, Ohio 45229, USA
| |
Collapse
|
50
|
Sindou MP, Mertens P. Decision-Making for Neurosurgical Treatment of Disabling Spasticity in Adults. ACTA ACUST UNITED AC 2004. [DOI: 10.1053/j.otns.2005.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|